Extracranial traumatic aneurysms due to blunt cerebrovascular injury

Clinical article

View More View Less
  • 1 Division of Neurosurgery, Department of Surgery, and
  • | 2 Department of Biostatistics, University of Alabama, Birmingham, Alabama
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Traumatic aneurysms occur in 10% of extracranial blunt traumatic cerebrovascular injuries (TCVI). The clinical consequences and optimal management of traumatic aneurysms are poorly understood.

Methods

A prospective study of TCVI at a Level I trauma center identified 7 patients with 19 extracranial traumatic carotid artery or vertebral artery aneurysms. An additional 6 patients with 7 traumatic aneurysms were followed outside of the prospective study, giving a total of 13 patients with 26 traumatic aneurysms. All patients were treated with 325 mg aspirin daily and underwent clinical and imaging follow-up beyond the initial hospitalization. Endovascular treatment was reserved for aneurysms demonstrating significant enlargement on follow-up imaging. Clinical and radiographic features were assessed.

Results

The 7 patients with traumatic aneurysms identified in the prospective cohort comprised 10.3% of all patients with TCVI. Two (15.4%) of the 13 total patients suffered an ischemic stroke in the setting of TCVI with traumatic aneurysm formation. No patient experienced an ischemic stroke or new symptoms after the initiation of antiplatelet therapy. Clinical and radiographic follow-up averaged 15.8 months (range 0.4–41.7 months) and 22.0 months (range 6.6–55.7 months), respectively. Ten (38.5%) of 26 aneurysms were not visualized on last follow-up, 10 (38.5%) were smaller, 1 (3.8%) was unchanged, and 5 (19.2%) were larger. Saccular aneurysms were more likely to enlarge than fusiform aneurysms (33.3% vs 11.8%). Results of a Fisher exact test tend to support the assertion that the 2 different aneurysm morphologies behave differently (p = 0.07). Two saccular aneurysms were treated with stenting.

Conclusions

The majority of traumatic aneurysms can be managed with an antiplatelet regimen of 325 mg aspirin daily and serial imaging. Saccular aneurysms have a greater tendency to enlarge when compared with fusiform aneurysms.

Abbreviations used in this paper:

CA = carotid artery; CTA = CT angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; TCVI = traumatic cerebrovascular injury; VA = vertebral artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Akiyama Y, , Nakahara I, , Tanaka M, , Iwamuro Y, , Hayashi J, & Harada K, et al.: Urgent endovascular stent-graft placement for a ruptured traumatic pseudoaneurysm of the extracranial carotid artery. J Trauma 58:624627, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Biffl WL, , Moore EE, , Offner PJ, , Brega KE, , Franciose RJ, & Burch JM: Blunt carotid arterial injuries: implications of a new grading scale. J Trauma 47:845853, 1999

    • Search Google Scholar
    • Export Citation
  • 3

    Biffl WL, , Ray CE Jr, , Moore EE, , Franciose RJ, , Aly S, & Heyrosa MG, et al.: Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg 235:699707, 2002

    • Search Google Scholar
    • Export Citation
  • 4

    Biffl WL, , Ray CE Jr, , Moore EE, , Mestek M, , Johnson JL, & Burch JM: Noninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report. J Trauma 53:850856, 2002

    • Search Google Scholar
    • Export Citation
  • 5

    Burlew CC, , Biffl WL, , Moore EE, , Barnett CC, , Johnson JL, & Bensard DD: Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg 72:330337, 2012

    • Search Google Scholar
    • Export Citation
  • 6

    Chimowitz MI, , Lynn MJ, , Derdeyn CP, , Turan TN, , Fiorella D, & Lane BF, et al.: Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:9931003, 2011

    • Search Google Scholar
    • Export Citation
  • 7

    DuBose J, , Recinos G, , Teixeira PG, , Inaba K, & Demetriades D: Endovascular stenting for the treatment of traumatic internal carotid injuries: expanding experience. J Trauma 65:15611566, 2008

    • Search Google Scholar
    • Export Citation
  • 8

    Eastman AL, , Chason DP, , Perez CL, , McAnulty AL, & Minei JP: Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime?. J Trauma 60:925929, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Edwards NM, , Fabian TC, , Claridge JA, , Timmons SD, , Fischer PE, & Croce MA: Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from longterm followup. J Am Coll Surg 204:10071015, 2007

    • Search Google Scholar
    • Export Citation
  • 10

    El-Sabrout R, & Cooley DA: Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg 31:702712, 2000

  • 11

    Emmett KP, , Fabian TC, , DiCocco JM, , Zarzaur BL, & Croce MA: Improving the screening criteria for blunt cerebrovascular injury: the appropriate role for computed tomography angiography. J Trauma 70:10581065, 2011

    • Search Google Scholar
    • Export Citation
  • 12

    Fabian TC, , Patton JH Jr, , Croce MA, , Minard G, , Kudsk KA, & Pritchard FE: Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. Ann Surg 223:513525, 1996

    • Search Google Scholar
    • Export Citation
  • 13

    Fusco MR, & Harrigan MR: Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery 68:517530, 2011

  • 14

    Griessenauer CJ, , Fleming JB, , Richards BF, , Cava LP, , Curé JK, & Younan DS, et al.: Timing and mechanism of ischemic stroke due to extracranial blunt traumatic cerebrovascular injury. Clinical article. J Neurosurg 118:397404, 2013

    • Search Google Scholar
    • Export Citation
  • 15

    Harrigan MR, , Hadley MN, , Dhall SS, , Walters BC, , Aarabi B, & Gelb DE, et al.: Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery 72:Suppl 2 234243, 2013

    • Search Google Scholar
    • Export Citation
  • 16

    Kim JJ, , Dillon WP, , Glastonbury CM, , Provenzale JM, & Wintermark M: Sixty-four-section multidetector CT angiography of carotid arteries: a systematic analysis of image quality and artifacts. AJNR Am J Neuroradiol 31:9199, 2010

    • Search Google Scholar
    • Export Citation
  • 17

    Malhotra AK, , Camacho M, , Ivatury RR, , Davis IC, , Komorowski DJ, & Leung DA, et al.: Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 246:632643, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Miller PR, , Fabian TC, , Bee TK, , Timmons S, , Chamsuddin A, & Finkle R, et al.: Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma 51:279286, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Pham MH, , Rahme RJ, , Arnaout O, , Hurley MC, , Bernstein RA, & Batjer HH, et al.: Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery 68:856866, 2011

    • Search Google Scholar
    • Export Citation
  • 20

    Prêtre R, , Kürsteiner K, , Reverdin A, & Faidutti B: Blunt carotid artery injury: devastating consequences of undetected pseudoaneurysm. J Trauma 39:10121014, 1995

    • Search Google Scholar
    • Export Citation
  • 21

    Safran MJ, , Greenwald MJ, , Rice HC, & Polin KS: Cervical spine dislocation presenting as an isolated Horner's syndrome. Arch Ophthalmol 108:327328, 1990

    • Search Google Scholar
    • Export Citation
  • 22

    Stein DM, , Boswell S, , Sliker CW, , Lui FY, & Scalea TM: Blunt cerebrovascular injuries: does treatment always matter?. J Trauma 66:132144, 2009

    • Search Google Scholar
    • Export Citation
  • 23

    Touzé E, , Randoux B, , Méary E, , Arquizan C, , Meder JF, & Mas JL: Aneurysmal forms of cervical artery dissection: associated factors and outcome. Stroke 32:418423, 2001

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 500 188 19
Full Text Views 577 36 2
PDF Downloads 311 34 2
EPUB Downloads 0 0 0